NJ: Definition, I don’t know. Go to the dictionary, and 1a you measure with a ruler. I agree completely that everyone has a different perspective, and everyone throws out meanings, and everyone has a different definition. I think the basic concept is, are you treated fairly? And “fairly” is situational. What’s fair in one group is not fair in another. I think as long as each individual member is treated fairly within their own group, that’s what should count.
SB: I think that coming from our section’s perspective, ACEP was fairly clear in how they defined democratic groups. They had a policy that was adopted back in ’08 and reaffirmed in 2014. I believe EM groups are defined by their governing body that is subject to change by fair and transparent elections that embody a one-vote, one-person structure and philosophy or representative vote recognizing equity, ownership, or seniority within the group. This governing body or electorate will control the finances and the decision making in the group. Again, it’s a longer policy, but those are the primary points. How do you measure democracy? I think that is reflective in at least some of the things that our Board of Directors tried to establish. They’re not true metrics, but it says that all the members should have a right to petition the governing body for their grievances, access to a fair due-process procedure, freedom to speak within the business confines of the group in a nondisruptive manner that should be exercised without fear, and lastly, an equal and realistic ownership opportunity within their group. Alluding to some of the comments by the last two folks, several of those elements are very much about fairness—due process, how you’re treated.
RM: Let’s keep going around for other insights in terms of how you might measure that. Lynn, you want to jump in?
LM: I guess to the typical person, I think when you ask what democracy is, it mostly means one person equals one vote on all material things. In reality, most democracy is one person, one vote, but in general, it’s one person, one vote on things that come to a vote, not necessarily on all things that matter to that entity or organization or group. I wouldn’t even quarrel that the best definition of democracy is one person equals one vote on everything that matters. To me, the question is, is that the best or is that even a common model in emergency medicine today? In addition, I would say it’s neither common nor best if that precise definition is actually the definition.